Disease Prevention and Health Promotion for Seniors
Introduction
What are you supposed to do with all the information about disease prevention and health promotion constantly bombarding you from television, radio, magazines, newspapers, Internet and sensationalist tabloids? How can you tell which preventive measures apply to you at your age, with your lifestyle, with chronic diseases you may (or may not) have? How can you judge whether exercise, moderate daily alcohol intake, or cholesterol reduction is good for you? The answer: it may not be easy. This article will attempt to help you evaluate which preventive measures and health promotion activities are applicable to you.
First, Talk To Your Doctor
Believe it or not, even though doctors are often accused of not paying enough attention to disease prevention and health promotion, they remain your best source for accurate data and opinions. However, if your physician rarely discusses prevention with you, it is important that you make it a point to bring up the subject and ask questions, either when you are in her/his office or on the telephone. Disease prevention and health promotion are just as important in the senior population as in younger age groups.
The Two Categories Of Prevention
We generally think of disease prevention in two categories.
- The first is primary prevention -- that is, stopping a disease or problem before it begins. One of the best examples of this is getting a yearly flu vaccination to prevent getting influenza.
- The other category is secondary prevention, or screening for occult (hidden) disease. A good example of this is obtaining periodic mammograms to detect breast cancer at a very early stage so it can be treated and cured.
While it is true that there are a number of unresolved controversies about prevention (for example, how often to obtain a mammogram; at what age, if ever, to stop getting pap smears; whether or not to screen at all for cancer of the prostate), there is a lot we do know and can recommend with confidence. I believe the best source for recommendations based upon good scientific evidence is Guide to Clinical Preventive Services (second edition, Williams and Wilkins publishers), the Report of the U.S. Preventive Services Task Force.
Which Diseases Can Be Prevented?
The leading causes of death in individuals age 65 and older that we can try to prevent, in order of decreasing frequency, are:
- heart diseases such as heart attacks and congestive heart failure.
- cancers, especially lung, colorectal (large bowel and rectum) and breast.
- cerebrovascular disease or strokes.
- chronic obstructive pulmonary disease; pneumonia, and influenza.
Primary Preventions: Immunizations, Life Style And Preventive Therapies
In terms of primary prevention, I recommend the following to all of my patients age 65 and over:
Immunizations
Influenza immunization ("flu shot"): A yearly flu immunization is extremely important and usually very beneficial, because true influenza can be a very serious and life-threatening disease.
The vaccine protects against both influenza A and influenza B (assuming that the make-up of the vaccine matches the type of influenza that is causing illness that season). It does not give you the flu, and adverse effects are very rare.
The best time to obtain the "flu shot" is mid-October through November each year. However, you can take it as early as September and as late as February or March.
Pneumococcal vaccination: This vaccination can be administered every five years, although some physicians say that only one pneumococcal vaccination is necessary for those over the age of 65.
Pneumonia is an infection in the lung tissue. Pneumococcal pneumonia is the most common type of bacterial pneumonia in older adults. It can be very serious and can cause death. The vaccine against pneumococcal pneumonia is very effective in helping to prevent this type of pneumonia, which is caused by a bacteria called the pneumococcus (a type of streptococcus). Even if you can’t remember whether you had this vaccination within the past five years, it is safe to take it again. Also, you can get vaccinated against pneumonia at the same time (in the other arm) that you receive your influenza vaccine. Adverse effects are very rare.
Tetanus and diptheria: Although tetanus and diptheria are relatively rare today, they are very serious diseases that are totally preventable by vaccination. Because you have likely been vaccinated previously in your life, all you need is a booster immunization once every 10 years.
Lifestyle changes
There are a number of life style changes you can make that are important primary preventive measures:
Alcohol and tobacco: The first lifestyle change is: don’t smoke tobacco. Quitting at any age is beneficial; it’s never too late. And limit alcohol to one drink daily. One glass of wine or beer daily is often beneficial for your heart and blood pressure. Never drive, go boating or swim after drinking alcohol.
Wear seat-belts: Remember to wear a seat-belt in an automobile.
Eat a well-balanced diet: Eat a diet rich in grains, fruits, vegetables, moderate amounts of protein and moderately limited in fat and cholesterol intake. Eating should be pleasurable. And remember that not eating enough may be even worse than over-eating.
Exercise: We have more and more evidence that regular physical activity, exercise, is good for your heart, blood pressure, bones, muscles, and sense of well-being. It is a wonderful preventive measure and can be very enjoyable. Walking, bicycling, gardening, and swimming are all excellent forms of exercise. Walking up and down stairs is great exercise that you can do no matter what the weather is outside.
Prevent osteoporosis: Preventing, or limiting, osteoporosis is important for women and for men also, although men develop osteoporosis less frequently and later in life than women. At the least, adequate calcium intake (1000 - 1500 mg daily) should be part of your diet. Women should discuss the benefits and risks of hormone replacement therapy and obtaining bone density studies with their physicians, because estrogens and other medications can be extremely helpful in preserving strong bones.
Have common sense: Here are a couple common sense preventive measure that apply not just to seniors, but to all of us:
- Keep the water heater in your house set at lower than 130 degrees. There is no need for water hotter than that, and very hot water can cause burns.
- Have smoke detectors in all appropriate places in your house or apartment.
Secondary Prevention: Screening
Turning now to secondary prevention, or screening for hidden disease, there are a number of things that you should seriously consider doing on a periodic basis, if you are over the age of 65.
Check your blood pressure: Have your blood pressure measured regularly (at least once a year). Hypertension, another name for high blood pressure, is a silent, symptomless disease that works over time to cause potentially serious problems with the heart, kidneys, eyes and brain.
Hypertension can be treated safely and effectively today. There are many medications available, so, working with your doctor, you should be able to find not only safe and effective drugs, but also drugs with no or few side effects.
Both parts of the blood pressure measurement are important: the systolic reading (top number) and the diastolic reading (bottom number). Isolated systolic hypertension (elevation of just the top number above 140 or 150) with a normal (below 90) diastolic reading is the most common type of high blood pressure in older individuals.
Check your vision and hearing: It is very important to have your vision and hearing checked regularly. Hearing impairment is very common as we age, but fortunately, with continuously improving technology, we can significantly help a majority of individuals who have suffered hearing loss. Hearing aids are getting smaller and better all the time. They really do not interfere at all with one’s physical appearance. Are you aware that Ronald Reagan, while he was President, wore a hearing aid? Bill Clinton wears a hearing aid also.
Hearing
It’s a good idea to have your hearing checked once a year. Your physician should be able to recommend an individual (speech and hearing specialist) or group where you can go.
Vision
As for vision, having the proper glasses for reading, driving and everyday tasks is obviously important. Checking eye pressure (intraoccular pressure) regularly (yearly) is important to detect early changes from glaucoma. Glaucoma is a slowly progressive disease resulting from high intraoccular pressure. It can be controlled with proper treatment, but can lead to blindness if it is not detected and treated in time. If you have diabetes or hypertension, regular eye exams are especially important because these diseases can cause changes in the retina in the back of the eye.
Watch for early stage cancers: There are a number of ways you can be proactive about cancer detection.
Breast cancer: For women, yearly breast exams by a physician or trained nurse, monthly self-breast exams and yearly mammograms are all helpful, at least up to age 75. I believe, despite a lack of proven evidence, that the same recommendations should hold true for anyone older than 75 years if you are in basically good health.
Cervical cancer: Pap smears are done to detect early cancer of the uterine cervix. It is a good idea to have a pap smear done if you haven’t had regular smears before age of 65, and if you are sexually active (especially with more than one partner).
Cancer of the colon and rectum: Both these cancers can be detected early by regular (every year or two) testing of the stool for occult (hidden) blood. Doing this test properly is very important, because if it is positive (blood is found in the stool) follow-up tests need to be done. These include a colonoscopy (using a long flexible tube to examine the rectum and entire large bowel, and to take a biopsy if necessary).
Be sure you understand the instructions about the diet you should follow for the test, and how to collect small stool samples. All this is very worthwhile, since colorectal cancers are common and are very serious.
Skin cancer: I believe a yearly skin exam is important also, because the very common skin cancers, basal cell and squamous cell, are totally curable when detected and treated early. Malignant melanoma, though far less common, is curable as well, but only if detected very early.
Lung and ovarian cancer: At present, there are no reliable screening tests to detect early lung or ovarian cancer.
Daily Supplements, Vitamins, and Herbs
I believe that calcium (as mentioned earlier), vitamin E (800 - 1200 I.U.), one aspirin (81 mg. or 325 mg.), and a multi-vitamin are reasonable on a daily basis. Mega (very large) doses of vitamins are a bad idea.
Summary
In summary, don’t smoke, or quit if you do smoke, eat a healthy diet and don’t under-eat, get regular exercise, and discuss with your physician which of the recommendations included here are best suited for you.
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